Risk factors for early-onset colorectal cancer in the United States: An epidemiologic investigation.

Abstract

92 Background: The rising incidence of colorectal cancer (CRC) in younger adults is a growing public health concern in the United States. The role of hypertension, obesity and other comorbidities in colon cancer has previously been studied, but to a lesser extent in early onset disease. We explore associations between early-onset CRC and key comorbidities. Methods: For adults below age 50, state-based CRC age-adjusted annual incidence rates (2017-2021) from the NCI State Cancer Profiles database were compared with state-based BRFSS 2023 demographic/health profile data (n=433,323) using R, a statistical software. Significant variables were selected after manual feature analysis. Structural equation modeling with path analysis yielded associations expressed as standardized regression coefficients. This approach encapsulated indirect and moderating effects while controlling for confounding. Results: The incidence of CRC and prevalence of hypertension and obesity were higher in the southern United States (including Mississippi, Louisiana, Alabama). The average state-based age-adjusted incidence ratio was 90.0 cases per million. Hypertension was associated with significantly increased state-based incidence of colorectal cancer: each 1% increase in a state’s hypertension prevalence corresponded to an additional 1.3 cases per million (β = 13.0, p < .001). Obesity did not directly influence CRC incidence, but had a significant indirect effect mediated through hypertension (indirect β = 5.9, p = .004). Female gender and rural residence were associated with increased CRC incidence through combined direct and indirect effects through obesity and hypertension (β = 11.3, p = .001; β = 0.3, p = .005). Conclusions: Our data analysis suggests an association between hypertension and early onset CRC, further investigation is warranted due to its potential as a target for interventions. While obesity has a known association with colon cancer, our study suggests that hypertension may contribute to this specific correlation more than previously understood, possibly due to shared inflammatory pathways. Female gender and rural residence were high risk demographic groups in the proposed link between obesity, hypertension, and CRC. Targeted prevention and primary care intervention efforts for hypertension and obesity may reduce early-onset CRC cases from a public health perspective. Increased concentration of these efforts should be dedicated to southern states, females, and rural communities.